Implementação da política de assistência farmacêutica e efeitos orçamentários da judicialização do acesso a medicamentos na Bahia, 2014 – 2019

Abstract

This thesis aims to analyze the process of implementation of the National Pharmaceutical Assistance Policy (PNAF) and the judicialization of access to medication in the state of Bahia, in the period from 2014 to 2019. Judicialization is defined here as a phenomenon resulting from institutional and individual actions with regard to the behavior of the Judiciary, in order to guarantee the fundamental right to health, as determined in the Citizen Constitution. This work is a theoretical empirical case study, qualitative in nature, that scales the expenses with the judicialization of Pharmaceutical Assistance, questioning how, in this aspect, the judicialization of medication interferes in the process of implementation of the National Pharmaceutical Assistance Policy (PNAF) in the State of Bahia. To achieve the research objectives, bibliographic reviews were carried out on the evolution of the Health and Pharmaceutical Assistance Policy in Brazil, cycle of public policies and neo-institutionalism, historical neo-institutionalism being the main theoretical foundation. Semi-structured interviews with key participants, document analysis and research in databases of the Bahia State Health Department and the State Attorney General's Office were carried out. Qualitative data were interpreted through content analysis, supported by NVivo software. The results indicate that: a) the judicialization of medication is increasing, and there was an increase in these expenses in the order of 73% in the analyzed period (2014 to 2019); b) the judicialization of medication stems from institutional, legal, economic, social, corporate and organizational reasons; c) organizational isomorphism is found between the groups that make up the Judiciary Branch, who understand judicialization as a strategy for implementing the Pharmaceutical Assistance Policy, and among the groups that make up the Executive Branch; d) the main actors that interfere in the implementation of the Pharmaceutical Assistance Policy, are doctors, lawyers, media, health secretaries, users and the pharmaceutical industry; e) Although the judicialization of medication is a problem for public management, the Pharmaceutical Assistance Policy was not discussed in the meetings of the Bipartite Intermanager Commission. The decrease of the judicialization of access to medication demands management capacity, mediation between the Judiciary and Executive Branches and regulatory bodies, instances of social participation and control, in addition to the organization of information, investment in the training of professionals and fast and specific interventions. It is hoped that the results of this thesis can contribute to increase theoretical knowledge about the implementation of Pharmaceutical Assistance Policy, and the need for coordination, in addition to collaborating with lines of future investigations. From an empirical point of view, it is suggested that the prioritization of this policy can identify solutions that involve different spheres of governments, the National Council of Justice, the Judiciary, and organizational civil society in the search for a consensus and the construction of management instruments capable of supporting decision-making, as well as, the introduction of improvements to reduce the effects of expenses with the judicialization of access to medication in the state of Bahia.